title: Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting.
abstract: OBJECTIVE
  Since the introduction of an endonasal endoscopic approach in transsphenoidal pituitary surgery, reports of perioperative olfactory changes have presented conflicting results. We examined the incidence of olfactory loss in cases of endoscopic transsphenoidal pituitary surgery with skull base repair using the nasoseptal flap (NSF) and the effects of monopolar electrocautery commonly used in designing the NSF.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Fifteen patients who underwent endoscopic transsphenoidal pituitary surgery with skull base reconstruction using the NSF were divided into cold knife (n = 8) and electrocautery (n = 7) groups according to the device used in the superior incision of the NSF. Patients were followed regularly to monitor the need for dressing or adhesiolysis around the olfactory cleft. All subjects received olfactory tests before and 6 months after surgery. Septal mucosa specimens obtained during posterior septectomy were incised with different devices, and the degree of mucosal damage was evaluated.
  
  
  RESULTS
  One patient in the electrocautery group demonstrated olfactory dysfunction postoperatively, but the other 14 patients showed no decrease in olfaction. In histologic analyses, 55.8% and 76.9% of the mucosal surface showed total epithelial loss when the mucosa was cut with cutting- and coagulation-mode electrocautery, respectively. In contrast, only 20% of the mucosal surface exhibited total epithelial loss when the mucosa was cut with a cold knife (P < .01).
  
  
  CONCLUSIONS
  Olfactory impairment is not common after use of the NSF. Use of the cold knife in making superior incision may reduce tissue damage with better olfactory outcomes.
authors.affiliation: Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Kyung Bum
authors.initials: KB
authors.lastname: Park
authors.forename: Roza
authors.initials: R
authors.lastname: Khalmuratova
authors.forename: Hong-Kyoung
authors.initials: HK
authors.lastname: Lee
authors.forename: Sea-Yuong
authors.initials: SY
authors.lastname: Jeon
authors.forename: Dae Woo
authors.initials: DW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004564:Electrocoagulation; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000637:transplantation*; D009300:Nasal Septum / Q000637:transplantation*; D010900:Pituitary Diseases / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*; D012903:Smell; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome